Overview
This guideline covers diagnosing and managing early and locally advanced breast cancer. It aims to help healthcare professionals offer the right treatments to people, taking into account the person's individual preferences.
For information on related topics, see our breast cancer summary page and our guideline on suspected cancer: recognition and referral. NICE has also produced guidelines on advanced breast cancer and familial breast cancer.
Last reviewed: 14 April 2025
We reviewed the evidence and made new and updated recommendations on neoadjuvant treatment and gonadal function suppression.
We also added links to relevant NICE technology appraisal guidance throughout the guideline. This is to provide easy access to relevant guidance at the right point in the guideline only and is not a change in practice. The guideline has also been reordered to reflect the sequence of treatment by cancer type. For more details, see the update information.
This guideline updates and replaces NICE guideline CG80 and the section on lymphoedema in NICE guideline CG81 (both 2009). It also updates and replaces NICE technology appraisal guidance 107, 108, 109 and 112 (2006) and NICE evidence summary ES15 (2017).
Updates planned:
- January 2023: We checked the guideline and identified several areas for update. For details, see the surveillance decision.
Recommendations
This guideline includes new and updated recommendations on:
- triple negative (ER/PR/HER2-negative) breast cancer
- HER2-positive breast cancer
- endocrine therapy for hormone receptor positive breast cancer
- management of treatment side effects and menopausal symptoms
It also includes recommendations on:
- information and support
- pretreatment assessment
- assessment of tumour profile and genetic testing
- surgery to the breast and axilla
- breast reconstruction
- systemic anti-cancer therapy planning
- systemic anti-cancer therapy for all receptor subtypes
- hormone receptor positive, HER2-negative breast cancer
- adjuvant bisphosphonate therapy
- radiotherapy
- follow-up and lifestyle advice
- locally advanced inoperable disease
Who is it for?
- Healthcare professionals
- Commissioners and providers of breast cancer services
- People with early and locally advanced breast cancer, their families and carers
Guideline development process
How we develop NICE guidelines
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.